Nutrition & Physical Activity

Sneaking late night snacks might just seem like an unhealthy habit, but the truth is that night eating syndrome (NES) — and a related syndrome called sleep related eating disorder (SRED) — are actually diagnosable conditions for some people. NES is technically classified as disordered eating, but researchers believe it’s also related to sleep disorders, making it a sort of hybrid condition. In both NES and SRED, people consume significant amounts of food after dinner; usually about 35 percent or more of their daily calories are eaten late in the evening or in the night. The main difference is that folks with NES are fully conscious of their night eating, whereas those with SRED are usually completely or partially asleep when they are eating at night. Figuring out which of these sounds most like what you're experiencing might be the first step to seeking treatment. Since you’re specifically curious about NES, read on to hear about causes and treatments (but, if you’d like to know more about SRED, check out Mayo Clinic’s site).

Currently, scientists’ understanding is that NES may be your body’s attempt to compensate for improper levels of a hormone called serotonin. It turns out that many of the calorically-dense and carb-rich foods that night eaters choose are quite efficient at increasing serotonin in your brain. Because serotonin helps to regulate your sleeping and feeding cycle (your “circadian rhythm”), night eating might be your body’s way of self-medicating or signaling that your serotonin levels and circadian rhythm are out of whack. On top of that, studies show that levels of other hormones in your body — such as leptin, which suppresses hunger — also shift away from a normal cycle. Usually, your circadian rhythm would ensure that your sleeping hours aren’t interrupted by hunger; with NES, that isn’t the case.

While researchers admit that there’s still a lot to learn about NES, they do know that increasing your serotonin can help. Selective serotonin reuptake inhibitors (SSRIs) — typically prescribed as antidepressants — have been used successfully in those with NES to reduce post-dinner binging. If your night eating tends to be in the middle of the night rather than late evening, a different antidepressant, known as agomelatine, might be a better bet (it regulates melatonin levels, which are also related to your sleep-wake cycle). Because NES is a hybrid condition involving eating behaviors, sleep behaviors, and your mood, you could look into chatting with a registered dietitian, spending a night in a sleep lab, or seeking out psychotherapy. Seeing one or a combination of these providers may be the right formula for you.

As you digest this information, you might also consider the areas of your life that your night eating might be impacting. Physically, the consequences of untreated NES can include weight gain and a loss of appetite for daytime meals. But, there can be social and psychological factors to consider, too. How does your nighttime eating make you feel emotionally? Do your loved ones know you’re struggling with this, or do you hide your behavior? Do you see any ways they could support you? Are there changes to your environment — such as keeping high-calorie snacks out of the house — that you could test out? It’s possible, too, that feelings of anxiety or stress could be the reason for your off-kilter eating cycle. Whatever treatment option you ultimately pursue, know that there seems to be hope for finding a way to keep those square meals during the daytime, so you can get those uninterrupted zzzs at night.

For more information or to make an appointment, check out these recommended resources:

A frustrating part of developing an allergy as an adult, rather than as a child, is knowing what you’re missing! While allergies might be associated with children, there are some allergies — including ones to seafood and shellfish — that are actually more common in adults. For example, in the United States, 0.5 percent of adults are allergic to fish and 2.5 percent are allergic to shellfish, compared to only 0.2 percent of children allergic to fish and 0.5 percent allergic to shellfish. In some cases, adults may even have more severe reactions to allergens than ones experienced by children. It might also interest you to know that asthma, exercise, alcohol, and certain medications can increase sensitivity to various allergens. Unfortunately, the only proven way to treat seafood and shellfish allergies is to avoid them completely.

Being allergic to seafood or shellfish means a person who consumes or inhales even a tiny amount of it will have an anaphylactic reaction — which can be fatal — anywhere from a few minutes to eight hours after contact. Symptoms include swollen and itchy lips, mouth, and pharynx (inside the throat). Having intolerance to seafood or shellfish means a person will feel sick after eating it but will not go into anaphylactic shock. In general, adult-onset allergies are believed to occur due to cross-reactions, meaning that an allergy to one substance (like pollen) may eventually lead to an allergy to something with similar proteins (because the immune system hones in on them). Shrimp, crab, crawfish, lobster, squid, oyster, snails, mussels, clams, and scallops share the protein tropomyosinin common with cockroaches and dust mites. Studies have shown that a person who is allergic to one of these has a 75 percent chance of also being allergic to another from that same group . Being allergic to dust mites, for example, may later lead to an allergic reaction to shellfish.

Though complete avoidance of seafood and shellfish is recommended in the case of an allergy, you may need to be a bit of a detective to really be able to keep these foods out of your diet. Unfortunately, seafood or shellfish traces may be found in many products that would not seem suspicious, including but not limited to:

“Meatless” hot dogs, sausages, and pizza toppings

Worcestershire sauce

Some Caesar salad dressings

Vitamins

Soaps and cosmetics

Insecticides

Sauces and seasonings

Additionally, some restaurants may use oil to cook seafood and non-seafood dishes, which can lead to cross-contamination. A little bit of good news: iodine dyes used in medical procedures as well as the supplement glucosamine, are in fact safe for those with seafood or shellfish allergies, despite common misconceptions — whew!

Reader, you ask about remedies you can try to get rid of the allergy or alternatives you can eat when you miss the taste of seafood. One option, immunotherapy, or building up exposure to allergens little by little, has been shown to be beneficial in some cases and harmful in others. There is currently quite a bit of research on developing vaccines to prevent allergies and mutated versions of allergens that may be easier to tolerate than the original. At this time though, strict avoidance is the only sure way to prevent an allergic reaction to seafood and shellfish if you know you’re allergic. There are not many replacements for seafood or shellfish, because the meat is hard to replicate (in both texture and taste). Many vegetarian alternatives may have seafood or shellfish byproducts or flavorings, so it’s advised to avoid them if you’re allergic. There are also some vegan versions of shrimp and shellfish (that purport to contain no animal products or byproducts) available. Before heading to the supermarket, it might be good to speak with your health care provider about whether these options would be safe for you.

Making an appointment to get an allergy test from a specialist (if you haven’t already) is a good option to learn more about your specific allergies or intolerances. S/he can help you navigate your new dietary outlook and hopefully determine some safe and tasty alternatives!

For more information or to make an appointment, check out these recommended resources:

Before you say “Oh Shiitake!,” cultivated (rather than wild), cooked mushrooms are generally a healthy addition to your diet. As far as your concern over cancer-causing agents in mushrooms, some studies found that synthetic and chemically modified compounds, which included agaritine — a mycotoxin found in fresh mushrooms, produced carcinogenic effects in mice. However, in a follow-up study, the same effects could not be replicated and the methodology used in these studies has come under question. And while many mushrooms, including shiitake, are typically safe for consumption, there are a few causes for caution when it comes to eating fungi.

Mushrooms, including shiitake, have many health benefits. Of those, shiitake mushrooms can boast about:

containing soluble and insoluble fiber

being a good source of B1, B2, B12, C, D, and E vitamins

Though more research is needed, these particular mushrooms have demonstrated antioxidant, antimicrobial, and antiviral properties. They have also been found, in some studies, to support the immune system in protecting against the spread of cancer.

Shiitake are not the only mushrooms that are considered beneficial. While, again, more studies are needed, findings from current research examining benefits across several varieties suggest that mushrooms may contribute to health in the following ways:

by providing some protection against b-amyloid peptide toxicity in the brain and mild cognitive impairment, which are both precursors to dementia – (though so far, only detected in studies with mice)

by supporting weight management — particularly when substituting mushrooms for meat in the diet

by promoting oral health — found in a study where a mouthwash with shiitake extract was used to combat plaque buildup

While these preliminary findings are very promising, there are two points of caution when it comes to eating mushrooms. The first is that some mushrooms found in the wild — such as death cap, panther cap, and liberty cap — can be extremely poisonous! Short of having a mycologist or mushroom expert on hand to verify that a mushroom collected in the wild is safe, the recommendation is to refrain from eating any wild mushrooms. Secondly, eating raw or undercooked shiitake mushrooms can sometimes cause a condition called shiitake dermatitis, which manifests itself in the form of a rash lasting about one to three weeks. Cooking the nutritious shiitake mushrooms before eating them can minimize the risk of illness while still providing the health benefits found in the mushrooms.

If you have other nutrition questions, you may consider checking out the Go Ask Alice!Nutrition & Physical Activity archive. In the meantime, continue having fun cooking with fungi!

Your question isn’t cheesy at all: in fact, it's a great topic to ‘whey’ in on (pun definitely intended). It brings up some good points to keep in mind for those who are on gluten-free diets. And, you are correct: unless cheese is processed with gluten-derived food additives or cross-contaminated by a gluten-containing product, all cheese is naturally gluten-free! More generally, dairy products are a good food source of calcium and protein for those who need to avoid gluten in her/his diet.

You may be wondering why someone would need to know if a product is gluten-free. Let’s start with the basics: Gluten (the proteins that occur in grains like wheat, rye, and barley), are found commonly in breads, pasta, cakes, cereals, baked goods, and other products made from these grains. People with chronic diseases such as celiac disease may have an autoimmune response to these proteins; other people might choose to forgo gluten because reducing gluten has been linked with weight loss or weight maintenance.

Becoming gluten-free isn’t as simple as removing the bun from a hamburger. Gluten is found in more than just breads: products such as soy sauce, food additives like modified food starches and malt flavorings, and even vitamins that use gluten as a binding agent can all contain gluten. Some people with celiac disease are so sensitive to gluten that if you sliced regular bread with a knife and then use that same knife to cut a piece of gluten-free bread (thereby cross-contaminating it) it could trigger an immune response. So, knowing if something is gluten-free could be crucial for those folks. Because of this, the Food and Drug Administration (FDA) has issued a standard defining the terms “no gluten,” “free of gluten,” “without gluten,” and “gluten-free.” In order to bear this label, the food product must have a gluten limit of less than 20 parts per million (ppm). If you’re avoiding gluten, try to keep an eye out for these terms and labels on the foods you buy.

Is it possible that, as you suggest, the move to label the gorgonzola cheese as “gluten-free” is a marketing ploy? Maybe. On the other hand, for those with celiac disease or a high sensitivity to gluten, knowing that a cheese has not been cross-contaminated by gluten or processed using gluten-derived additives may mean it makes the cut (Get it? Cut the cheese? Is this mic on?).

Whether you’re gluten-free or not, sometimes being cheesy is a good thing!

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Just like fashion fads on the runway, fitness and diet fads will come and go. It’s smart to ask questions about any diet plan or exercise regimen to help separate fact from fiction, so kudos to you for seeking out additional information! Originally, ketogenic nutrition strategies were developed for treatment of seizure disorders in children and adolescents. The use of the “keto diet” (originally known as the ketogenic diet) as a weight loss strategy is relatively recent. And as far as shedding pounds is concerned, the keto diet seems to be most effective in the short-term, especially when combined with exercise. However, this diet is also associated some health risks — so it’s good to explore the benefits and potential drawbacks in tandem.

Your initial conclusions about the keto diet are correct — the structure is based on an extremely low-carbohydrate, high-fat, and high-protein ratio of calorie sources. The keto diet plan follows a strict regimen of high fat, high protein, low carbohydrate food sources. Your body, in response to obtaining calories primarily from fat and protein, works to break down fatty acids for fuel. In contrast, a diet high in carbohydrates primarily relies on glucose (sugar) for energy. Maintaining adequate blood sugar levels, or levels of glucose in the blood stream, help ensure your brain has enough fuel to work normally. When glucose is not readily available, your brain can use ketones for energy. The process of burning fatty acids for energy is called beta-oxidation, and produces a byproduct — the ketone molecule. The keto diet is based off of this switch from glucose fuel to ketone fuel. When your body is burning primarily fat, and not glucose, ketones are produced in excess.

As far as an effective weight loss strategy, the keto diet typically has the most dramatic results within the first four to six weeks due to the dramatic changes in eating habits. Current scientific research on the keto diet shows that those using this plan specifically for weight loss may experience moderate or significant weight loss in the beginning weeks, followed by less dramatic results in subsequent months. According to some reports, individuals who follow a keto diet for eight to twelve weeks may see an additional reduction in body fat. Of the literature available, most sources advise using the keto diet under the supervision of a health care professional because of the restrictive nature and potential side effects.

Additionally, some people find these types of diets challenging to maintain long term because of how strict the rules are around what you can and cannot eat. Depending on where you read about the keto diet as a weight loss tool, you’re likely to hear varying reports of effectiveness. While initially successful with weight loss goals, over time issues like depleted energy, food cravings, and other side effects may hinder continued ability to adhere to the diet. Given the specific guidelines of the keto diet, it may be harder to get a diversity of important vitamins and nutrients from food. Many health care professionals advise incorporating a multivitamin into your diet. Dehydration, constipation, and development of kidney stones are also possible side effects of the keto diet. Some initial research on long-term use of the keto regimen shows potential risks of developing insulin resistance and developing diabetes. Use of the keto diet may also lead to elevated cholesterol or unhealthy amounts of fat in the liver. And if the ketones build up in your body quickly and you can’t excrete them through the urine fast enough, you can drastically alter your blood pH, which can be fatal.

You also asked about results due to the combination of the keto diet and exercise. Historically, there have been mixed conclusions in research studies about whether combining the ketogenic diet with exercise provides faster weight loss results or impacts athletic performance. The most recent studies seem to imply that keto plus exercise may cause the body to burn fat for energy without negatively affecting athletic potential. That said, some study participants did show elevated blood fat levels, which could increase cardiovascular disease risks.

Want to figure out if the ketogenic plan is right for you? It might be best to consult a health care provider to avoid any potential health consequences and also to tailor the program to your needs. If your goals are weight loss, there are many ways to achieve sustainable, healthy results. You may want to browse the Go Ask Alice!weight loss or fitness archives for some additional ideas.

When it comes to workout DVDs, not all are created equal. What works for a friend may not work for you, and vice versa, which is why you should try to do as much research as you can before you press play. Also, keep in mind that it may take a few attempts or selections to figure out which one is the best fit for you.

Choosing a workout DVD can be tough because once you tear off that cellophane packaging, there’s usually little chance of being able to return it. So how do you make an informed decision? Here are a few tips that might help you in your quest:

Don’t believe the gimmicks. A workout DVD that advertises itself as a quick fix for muscle toning and weight loss is often misleading. Everyone’s body is different, so not everyone will achieve the same results. As you mentioned, you are trying to be more active and challenge yourself so visible physical changes aren’t necessarily indicative of achieving your end goal.

Credentials matter. Since there aren’t standard guidelines that dictate who can be featured on a workout DVD, consider who might be most qualified to give advice about fitness. A fit looking celebrity might not have much expertise in health and fitness. It’s a good idea to look for workout DVDs that feature an instructor who is accredited by a national agency like the American Council on Exercise (ACE).

Preview DVDs. Borrow DVDS from a friend, the library, or rent one to test it out for yourself. You might also find that full workout videos are posted online for free or for an affordable price. Reading user reviews online might also be helpful, but keep in mind that everyone has a different opinion on what works.

Take it slow. Since you’re new to the workout DVD world, look for those that offer beginner workouts. It may prove helpful to watch the entire video before jumping into your workout. That way, you can get used to the format and intensity before you get started. Get prepared! Do you have the space for the workout? Do you need to purchase any equipment?

Listen to your body. Is the instructor going too fast for you? Do you need a water break? You can do the exercises at your own pace by taking advantage of that pause button!

Don’t forget, the best workouts are ones that keep you fit and are also enjoyable. There’s more than one way to get in shape and many different exercises work the same muscles. Let’s say you detest lifting weights, you might find that a yoga DVD provides the same benefits as a weight lifting DVD. So don’t be afraid to try new techniques!

Before you begin any type of new exercise routine it’s always a good idea to consult a medical professional. If you’re a Columbia student, you can make an appointment at Medical Services (Morningside campus) or the Student Health Service (CUMC campus). You can also check out Columbia’s physical activity program, CU Move, for general tips on how to stay active and improve your fitness.

You’ll be happy to know that enjoying frozen yogurt is delicious AND may contain some “healthy” bacteria! While the research is not entirely conclusive, it seems that the active cultures you’re referring to (a.k.a. probiotics) do have the ability to survive the frozen treat’s freezing process.

However, not all frozen yogurts are created equal. So, how will you know which ones contain probiotics? Making these considerations will help you determine the probiotic content of your frozen yogurt:

Look for the Live & Active Cultures seal. This voluntary labeling program was created by the National Yogurt Association to certify that products contain live active cultures. However, be aware that while regular yogurt needs to have 100 million cultures per gram to get this seal, frozen yogurt needs just one-tenth this amount.

Check the ingredients. Are probiotics listed in the ingredients? A few common probiotic bacteria are species of Lactobacillus and Bifidobacterium, including Lactobacillus acidophilus and Bifidobacterium longum. Check to see if any of these are listed on the product.

Contact the manufacturer or store manager. If you find a frozen yogurt that piques your taste buds, but doesn’t have the seal or its probiotic content isn't displayed on the list of ingredients, it doesn’t necessarily mean it's without live active cultures. Try reaching out to the manufacturer to ask how much and what types of bacteria are in their product.

Consider the varieties and add-ins. Frozen yogurt’s probiotic content depends on the kind of yogurt it was made from, the manufacturing techniques used to process it, the other ingredients added, and the strains of probiotics included. And while it’s great that frozen yogurt may contain good bacteria, remember that extra sugar, add-ins, and toppings like sugary cereal, sprinkles, and chocolate chips or candy mean added calories to your treat.

Overall, regular yogurt beats out frozen yogurt when it comes to nutrient and probiotic content. Regular (not frozen) yogurt is a great source of many nutrients, including calcium, vitamins B and D, magnesium, potassium, and protein — in addition to natural and added live active cultures. While some varieties of frozen yogurt may contain probiotics, many just don’t measure up to regular yogurt’s nutrient and vitamin content. That said, it’s still a good option for a lower-calorie treat. And by being an informed and vigilant shopper, you’ll be able to identify which frozen yogurt will give the most bang for your buck, or rather bacteria per bite.

Enjoy!

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Delicious and nutritious foods can be found all over the world! Adopting a diet similar to that of another region could positively impact your health and add some variety to what you eat. Ultimately, it’s important to pick a diet that’s right for you and for your lifestyle.

Studying regional diets can (and should!) certainly impact what we decide to put on our plates. Some of the healthiest diets around the world tend to feature lots of fruits, vegetables, whole grains, and fewer servings of dairy, red meat, and poultry. They also limit unhealthy fats and instead include healthier ones. You might want to consider what types of foods you have available because not everything that is available in another country will be readily available where you are.

You specifically mentioned the Mediterranean and Japanese diets. The staples of the Mediterranean diet — which have been associated with a lowered risk of heart disease, cancer, Parkinson’s disease, and Alzheimer’s disease — are fruits, veggies, legumes, and nuts. Cooks also use olive oil instead of butter, limit the use of red meat, and incorporate fish several times a week. The Japanese diet has been linked to long lifespans and lowered risk of heart disease, but also hypertension (high blood pressure). Foods commonly found in the Japanese diet include eating a lot of omega-3-rich fish and protein-dense soy, drinking green tea, and limiting intake of sugar and white flour. Finding fresh olive oil or fresh fish might not be as easy, or inexpensive, for you as it is for someone living on the Mediterranean coast or in Tokyo, but you do not need to eat these all the time. Fresh fruits, veggies, beans and nuts might be easier to come by depending on where you live.

Overall, the ideal diet for you depends on a lot of things, such as your genetic makeup, hormonal profile, culture, and food preferences. The USDA Ethnic/Cultural Food Pyramids display recommendations for healthy eating from many different countries. Reviewing these may help you find food choices that work for you. You may also want to check out the get balanced! Guide for Healthier Eating to look at other healthy food options. Foods that are easily accessible and your level of physical activity are also factors to consider when choosing what to eat. Talking to a health professional may also be helpful — if you’re a Columbia student, you can make an appointment to speak with a registered dietitian or a health care provider at Medical Services (Morningside) or the Student Health Service (CUMC).

Ever try freeze-dried ice cream in a pouch designed for astronauts? Well, freeze-dried foods are no longer just for space travel! They are now available to anyone who enjoys snacking on the go and there are a lot more options than just ice cream.

The main difference between freeze-dried foods and fresh foods is water. Freeze-drying is a process that preserves food by removing 98 percent of its water content. This prevents food from spoiling, while still maintaining most of its flavor, color, texture, and nutritional value. Some freeze-dried food can last for several years! Just remember that if you’re eating a lot of freeze-dried foods, you want to stay extra hydrated to make up for their lack of water. Also keep in mind that the freeze-drying process involves chemical treatments. While most of the chemicals used in these processes are FDA approved and regulated, it is good to be aware that some chemicals may have adverse health effects, particularly for those who have a sulfite sensitivity. So, the question is, are freeze-dried fruits and veggies good for you?

Research has shown that while freeze-dried fruits and vegetables contain slightly lower amounts of certain vitamins, they are rich in antioxidants and fiber. Most researchers agree that the amount of nutrients lost from freeze-drying is miniscule.

What about calories? Because freeze-dried fruits and vegetables lack water, they are highly concentrated, which means they contain more calories than their original form. Confused? Think about it like this — if one cup of a particular fresh fruit is 100 calories, when you freeze dry that same amount of fruit it will shrink in size. So, one cup of freeze-dried fruit will contain more pieces of fruit than one cup of fresh fruit. This translates to more calories. This is why nutrition experts recommend that freeze-dried foods might be added as a supplement to someone’s diet, but should not act as a replacement for fresh foods.

In any form, fruits and vegetables provide you with vitamins and nutrients that are essential to your health. Whether you choose fresh or freeze-dried, it’s a good idea to include plenty of fruits and vegetables in your daily diet. The recommended number of servings varies from person to person, but general guidelines suggest between two and six servings daily. You can calculate your recommended daily intake on the Centers for Disease Control and Prevention website.

Eating gluten-free certainly warrants paying attention to what you are excluding and how that may impact your health. Good for you for thinking carefully about your diet and asking questions. As someone with celiac disease, it's even more important to learn about how your food choices may impact the amount of certain vitamins and nutrients in your meals.

Let’s start with some basic facts about gluten-free diets. While eating a gluten-free diet is advised for those with celiac disease, it is not a quick fix, and it is not a flawless nutritional regimen.

The pros? Removing gluten will reduce inflammation and hopefully reduce damage to the intestines caused by celiac disease. Initiating and maintaining a gluten-free diet is universally recommended as a lifelong treatment for those with celiac disease.

The cons? Gluten-free diets/foods may be low in certain nutrients (like B vitamins, calcium, vitamin D, iron, zinc, magnesium, and fiber). Many gluten-free packaged foods may also be higher in fat and cholesterol.

One way, and perhaps the preferred option, for increasing your intake of vitamins is through food. Some food sources of B-vitamins, calcium, fiber, folate, iron, magnesium, vitamin D, and zinc are:

Vitamin D is exceptionally hard to find in a wide variety of foods. The foods with the highest levels of vitamin D per serving are cod liver oil, swordfish, salmon, and tuna. Vitamin D is also produced in our bodies when we exposed to sun. For this reason, many people in northern climates have lower levels and may take supplements. You may want to talk with your health care provider to determine whether taking vitamin D supplements in addition to food sources is right for you.

Maintaining a healthy diet is important for everyone — and especially for those with celiac disease. Some good tips to get the most benefits from your food are:

Opt for fresh produce, whenever possible. Fresh vegetables and fruits will have the highest levels of vitamins. Also try to eat foods that are grown local and in season. If you can’t always eat fresh, frozen is second best.

Don’t overcook vegetables. Cooking vegetables too long will detract from their nutritional value. Using various cooking methods like sautéing, steaming, blanching, or even baking your veggies will reduce the amount of vitamins and minerals lost so your veggies will still pack a nutritious punch!

Aim for “whole” foods. The fewer ingredients in your food, the better. One way of doing this is to avoid processed and packaged goods. Processed foods will have higher levels of unhealthy fats, sodium, and sugars.

Eat the rainbow! A diet that includes a variety of colors (like those found in fruits and vegetables) is indicative of different vitamins. Keeping your plate or bowl colorful will ensure you’re eating a wide range of nutrients.

Before beginning a new nutritional program or diet, consider talking with your health care provider about the pros and cons and whether it is right for you. Additionally, a registered dietitian can give you in-depth information about the benefits and risks of excluding and including specific foods or supplements. If you are a Columbia student, you can make an appointment to speak with a registered dietitian or a health care provider by contacting Medical Services (Morningside) or the Student Health Service (CUMC). Checking out the Academy for Nutrition and Dietetics' celiac disease page may also help you get ideas on what to look for at the grocery, how to decipher what is gluten-free, and links to other helpful websites.